摘要
目的:了解特发性震颤( ET)患者、帕金森病( PD)患者和健康对照组的认知障碍发生情况及相关因素。方法2009年9月至2013年9月采用蒙特利尔认知评估( MoCA )、汉密尔顿抑郁量表( HAMD)对苏州大学附属第二医院门诊的62例ET患者、61例PD患者和60名健康对照组的认知功能及抑郁进行评估。结果认知障碍在ET患者发生率为38.7%,PD患者发生率为44.3%,健康对照组发生率为23.3%,差异有统计学意义( P<0.05)。健康对照组、ET组、PD组3组MoCA各因子比较结果:视空间/执行得分为(4.1±1.0)分、(3.8±1.1)分和(3.2±1.6)分,命名得分为(2.9±0.4)分、(2.8±0.6)分和(2.3±0.8)分及延迟回忆得分为(3.9±0.9)分、(2.7±1.3)分和(2.5±1.7)分,差异均有统计学意义(均P<0.01),而注意力、语言、抽象及定向差异无统计学意义;进一步两两比较ET组与PD组MoCA各因子比较结果:两组视空间/执行得分为(3.8±1.1)分和(3.2±1.6)分,命名得分(2.8±0.6)分和(2.3±0.8)分,差异有统计学意义(P<0.05),而两组命名、注意力、语言、抽象、延迟回忆及定向差异无统计学意义。 ET患者的认知功能评分与血尿酸、教育水平、抑郁评分和TRS评分显著的相关性(r=0.589,P=0.000;r=0.449,P=0.010;r=0.452,P=0.009;r=0.466,P=0.025), PD患者的认知功能评分与血尿酸、教育水平、抑郁评分和UPDRS-Ⅲ评分显著的相关性( r=0.694, P=0.000;r=0.614, P=0.000; r=0.604, P=0.000; r=0.376, P=0.000)。结论最常见的两个运动障碍疾病ET和PD认知障碍有较高发生率,常见症状多为视空间能力下降、执行力差、延迟回忆能力下降等,ET组视空间/执行能力、命名能力受损较PD是轻度的。认知功能评分与受教育年限、血尿酸水平呈正相关,与抑郁评分、运动障碍评分呈负相关。
Objectve To explore the incidence of cognitive dysfunction and associated factors in 62 essential tremor (ET) cases, 60 normal controls and 61 Parkinson′s disease (PD) cases.Methods A total of 62 ET and 61 PD patients from September 2009 to September 2013 were recruited from our outpatient clinic.ET patients received the Tremor Rating Scale for Tremor-motor examination ( items 1-15 of rating scale) while 61 PD patients were examined with the Unified Parkinson′s Disease Rating Scale ( UPDRS)-motor examination and a modified Hoehn and Yahr scale for staging disorder severity .All participants completed Montreal Cognitive Assessment ( MoCA) Beijing version for measuring cognitive functions .And depression was evaluated by the Hamilton Depression Scale ( HAMD) .The serum levels of uric acid were tested.Results A MoCA score 〈26 ( at least mildly cognitive ) was observed in 14 ( 23.3%) normal controls, compared to 24 (38.7%) ET cases and 27 (44.3%) PD cases ( P=0.045 when comparing all 3 groups, and P=0.532 when comparing ET and PD ).The factor scores of visual space/execution were 4.1 ±1.0, 3.8 ±1.1 and 3.2 ±1.6 in normal controls, ET and PD patients, the factor scores of naming 2.9 ±0.4, 2.8 ±0.6 and 2.3 ±0.8 in control, ET and PD patients, the factor scores of delay memory 3.9 ±0.9, 2.7 ±1.3 and 2.5 ±1.7 in control, ET and PD patients.Statistical differences existed in visual space/execution , naming and delay memory ( P〈0.05 ) among 3 groups.Yet there were no statistical differences in attention , language , abstract and directional among 3 groups.Statistical differences existed in visual space/execution and naming between ET and PD patients ( P〈0.05).PD cases had the lowest visual space/execution score , followed by ET ( intermediate ) and highest scores in controls ( P〈0.05 ).In ET patients, cognitive scores were correlated with serum levels of uric acid , education, tremor Rating Scale for Tremor-motor subscale score and depression levels ( r =0.589, P=0.000; r =0.449, P =0.010; r =0.452, P=0.009;r=0.466, P=0.025).In PD patients, cognitive scores correlated with serum levels of uric acid, education, score of UPDRS-Ⅲ and depression levels ( r=0.694, P=0.000; r=0.614, P=0.000;r=0.604, P=0.000;r=0.376, P=0.000).Conclusion The incidence of cognition is higher in ET and PD.There were no significant inter-group differences for cognition frequency.The most frequently endorsed symptoms were poor visual spatial ability , execution disturbance and delayed recall disorders.Some connition scores in ET were intermediate between those of PD cases and normal controls .Thus a mild form of connition dysregulation may be present in ET.The degree of cognition symptoms is correlated with serum levels of uric acid , education and serious motor.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第31期2412-2416,共5页
National Medical Journal of China
基金
江苏省重大神经精神疾病诊疗技术研究重点实验室(BM2013003)
江苏省医学领军人才与创新团队专项经费
苏州市临床重点病种诊疗技术专项(LCZX201304)
苏州市科技发展计划(SZS201205)
关键词
特发性震颤
帕金森病
认知功能
Essential tremor
Parkinson′s Disease
Cognition